Mission: Free-market enemy or health care savior?

The medical community in Western North Carolina is embroiled in a debate over Mission Hospital — should its influence and reach be reined in or given the freedom it needs to serves as the region’s health care leader?

A state committee is examining whether Mission needs more checks on its health care monopoly, and will hold a public hearing on the issue at 6 p.m. Thursday, Oct. 20, at the WNC Agricultural Center in Asheville.

Physicians in surrounding counties fear encroachment by Mission could siphon patients away from their local hospitals to Asheville, despite the same quality of care and caliber of physicians serving in their community closer to home.

“You have to have a certain volume of business to be viable,” said David Markoff, an ophthalmologist in Haywood County. “At some point, you reach this tipping point where you can’t keep quality health care locally because the physicians aren’t busy enough.”

Mission has made overtures to buy physician practices in Haywood County and has set up an outpatient clinic for doctors from Asheville to hold office hours in Haywood on select days. If successful, this could result in patients being sent to Mission for procedures and take business away from MedWest-Haywood.

Janet Moore, vice president of communications for Mission, said Mission is trying to fill in gaps of medical specialties that aren’t accessible now, citing a doctor shortage in America that could grow more acute for the region.

Yet that doesn’t explain why Mission is courting local doctors to join its payroll, nor accounts for all the doctors, including general orthopedists, coming over the county line to set up shop in Haywood.

“Rather than stepping back with the patient at the center saying what’s right for the region, we have a lot of politicking, frankly,” Moore said.

Mission, however, isn’t the only one playing offense. Carolina’s HealthCare System has brought four hospitals in the region — including Haywood, Jackson and Swain — under its management umbrella. It is based out of Charlotte and dwarfs Mission.

“Carolinas has a footprint that reaches from Murphy to Manteo,” Moore said.

Mission seems to be concerned that Carolinas could funnel specialty care away from it. It is a troubling prospect as Mission’s thin margins grow even thinner. More patients lack insurance and are being written off as charity cases, while Medicaid and Medicare continue to reduce their level of reimbursements to hospitals.

“What you have is a pie that isn’t getting any bigger,” Moore said. “Nobody can afford to lose market share. Everybody wants to stay where they are or get better.”

Markoff said Asheville has attracted lots of doctors since it is such a desirable place to live.

“Asheville has too many physicians for the patients in Buncombe County. They have to pull patients in from surrounding counties to keep their physicians happy,” Markoff said.

Mission is governed by anti-trust regulations dating back to its merger with St. Joseph’s 15 years ago.

“We are the most regulated hospital in the state of North Carolina and in the United States. We live under a microscope and have for 15 years,” Moore said.

Mission sent out a mass email to employees and community members encouraging them to come out and voice support for Mission.

“If you are an employee who is planning on attending and would like a boxed dinner, please click below,” the email read.